English abstract

The aim of this dissertation was to analyse the CroDiab registry status, estimate the rate and dynamics of the registration of type 2 diabetic patients, create a model of chronic diabetes complication development and mortality as assessed by glycaemic control (HbA1c), and assess the long-term effect of quality inclusion and follow-up of relevant CroDiab data on chronic complications and mortality by means of simulation. The research was carried out by analysing the CroDiab registry data, assessing simulation parameters according to the literature and the results obtained, and applying simulation model designed to simulate changes in the frequency of diabetic complications and death of persons with diabetes over a 20-year period depending on the proportion of diabetic population registered. Simulation was performed on data aggregated for persons suffering from type 2 diabetes in Croatia that have been registered by primary health care providers. Results point to a significant proportion of patients included in the CroDiab registry, although the number of annual quality records on the primary care level is still unsatisfactory (5%). Type 2 diabetes is the most frequent type of disease, accounting for 93.66% of the patients, type 1 diabetes is next (6.15%), whereas all other types are significantly less frequent (0.19%). Adherence to treatment was shown to be inadequate, as more than 60% of the type 2 patients did not achieve target values of any of the studied metabolic parameters. More than half of all the patients with type 2 diabetes in Croatia had at least one chronic complication of diabetes (56.16%). Continuous registration and survey of the CroDiab registry led to a significant improvement in the majority of metabolic parameters which, when reporting was intermittent, was less marked. Simulation results showed that out of the 78,000 patients without complications, only 11,389 would not have developed chronic complications or die over a span of 20 years but for registrations and survey in the CroDiab registry. Simulations together with a gradual increase in patient coverage by quality registration showed an increasing number of diabetic patients without complications, and those with complications on account of a smaller number of patients who died within a 20-yr period. A complete registration coverage in Croatia might, on a national level and over a period of 20 years, save as much as 3,505 of known patients. The results of this dissertation are of a major public health interest, as they showed that Croatia has a developed and established efficient system of secondary and tertiary prevention within the diabetes care system, with a big, although as yet insufficiently used potential.